After Hours Telephone Care

​​​Each pediatric practice must evaluate how best to manage after-hours calls. The choices may include a traditional telephone answering service and a professional after-hours call center.

Important Factors

Whether a professional after-hours call center or a traditional telephone answering service is chosen to screen calls, the pediatric practice should obtain basic information before a specific service is chosen. A list of recommended providers can often be obtained from a local professional society or affiliate hospital and augmented with recommendations from colleagues.

Before contacting a prospective call center or telephone service, prepare a set of policies that include your:

• Practice office hours and location
• Usual sign-in and sign-out times of covering doctors
• Backup telephone numbers for each covering doctor
• Usual procedure for retrieving non-urgent messages (e.g. calling-in every 90 minutes)
• The practice's preferred hospital for emergencies
• Procedures to follow if a covering physician cannot be reached.

This list should be used to discuss specific practice concerns and how they will be managed by the service. It is preferred that an answering service or call center be electronically connected to the practice to facilitate immediate information sharing with the on-call physician or when the practice opens the following morning. The encounters should be reviewed promptly by a physician or registered nurse who is able to review and determine whether follow-up calls are needed. The log can then be maintained for office use and pertinent data can be entered into a patient’s chart. The chosen answering service or call center must be HIPAA compliant and sign a Business Associate Agreement.

Other topics for discussion should include:

• The number of call-screeners available
• The usual waiting time before calls are answered
• Contingency plans in the event of computer or telephone failure.

Projected monthly charges based on the usual practice call volume should be reviewed at the time of this discussion.

Additional AAP Telephone Care Resources

• Sample Office Policy
  A sample policy entitled, “After-Hours Phone Calls and Web Messaging” that can be customized for use in your practice.
• Pediatric Telephone Protocols, 17th Edition
  A go-to resource for telephone care triage, which covers a broad spectrum of caller concerns.
• Pediatric Nurse Telephone Triage
  A decision-support tool that is a companion to Pediatric Telephone Protocols, and helps office staff deliver superior telephone advice.
• Breastfeeding Telephone Triage and Advice
  Resource to help nurses, lactation professionals, and other medical staff confidently advise breastfeeding mothers by phone.